ONLINE REGISTRATION

You may complete this form online before printing.

 


I. GENERAL INFORMATION

Name & Last name
Company / Institution:
Telephone: Mobile phone:
E-mail:
Address:
DNI / CE
Name Company:
Address Company:
RUC (Only Peru)
   

II. US$ RATES. Taxes not included (18%)

CATEGORY Up to April 30th May, 1 - June, 15 June 16 - October 15
Members $ 300.00 $ 350.00 $ 450.00
Non Members $ 400.00 $ 450.00 $ 550.00
Students Members   $ 50.00
Students Non Members * $ 100.00
Professors $ 80.00 $ 80.00 $ 80.00

* Students who are not SGP Members, please attach record of full-time registration at the University.

III. SGP GALA DINNER: Price per person $ 100.00

IV. PAYMENT:

Cash or company check sent to the offices of SGP.(Av. 28 de Julio 745, Miraflores - Lima 18)

Deposit CTA.CTE. US$. BANCO DE CREDITO DEL PERUNr. 193-1617598-1-82:

Attach deposit:  

Wire Transfer CTA.CTE. US$. BANCO DE CREDITO DEL PERU. CTA. N° 193-1617598-1-82 SWIFT: BCPLPEPL CCI 002-193-001617598182-14.
Attach deposit:  

Credit Card Nº:
Expiration Date (MM/YY)
Card Holder's Name:
Country:
Passport Number:
Amount to be charged US$:

Fees for banking services must be borne by the participant.

This form will not be processed if not accompanied by all requested payment documents. For credit card users, information must be clear and legible.

XVII Peruvian Geological Congress
Av. 28 de Julio 745, Miraflores, Lima, Perú
+511 4441180 / +511 6281150
E-mail: congreso@sgp.org.pe

 

Copyright © 2013 Todos los Derechos Reservados